Marsi Kerr, CRNA, MS, begins placement of the GlideScope video laryngoscope (Verathon Inc) for a trauma patient with a possible cervical spine injury at Allegiance Health in Jackson, Michigan. Allegiance is a community-owned health system with a team of 26 staff nurse anesthetists that provide anesthesia services to improve the health and well being of the people of the community at every stage of life. (Photograph taken by David Thomas, MPhil, and submitted by Ponda Sallee, CRNA, MHS.)
Management of a Pulmonary Artery Embolectomy and Recurrent EmbolusThis case report describes a woman with a diagnosis of massive pulmonary embolism who was brought to the operating room for emergent pulmonary artery embolectomy. Pulmonary emboli are complex syndromes of altered coagulation and perfusion that remain prevalent among the population, especially the hospitalized. It is the author’s opinion that attentiveness to the subtle embolic pathology and the anesthetic readiness directly facilitated this patient’s survival and management of a critical pulmonary thromboembolus and pulmonary artery embolectomy.
Anesthetic Management for Implantation of a Treatment Device: The Rheos Baroreflex Hypertensive Therapy SystemThe author of this case report explains that the Rheos Baroreflex Hypertension Therapy System reduces the sympathetic outflow and increases the parasympathetic outflow via the activation of the carotid baroreflex. This system has been proved to be a successful treatment of resistant hypertension through many studies conducted and sponsored by CVRx. The successful implantation and mapping of the Rheos system is critically dependent on the selectivity and the administration of the anesthetic agents that minimally inhibit the carotid baroreceptor reflex.
Simulation Training for Advanced Airway Management for Anesthesia and Other Healthcare Providers: A Systematic Review In this review article, the authors studied the current literature on human patient simulation for preparing anesthesia and other healthcare providers for advanced airway management. A systematic review was conducted of articles published between 1990 and 2009 on advanced airway management for patients undergoing anesthesia and patients who are not. The majority of the studies included simulation education evaluation for a variety of medical, nursing, and allied health providers and students.
Keywords: Difficult airway management, general anesthesia, patient safety, simulation training.
Version: 2012;80(1):25-31.Authors: Karen E. Lucisano, CRNA, MSN,
Laura A. Talbot, RN, EdD, PhD, GCNS-BC
Myocardial Infarction and Pregnancy: A Case ReportCoronary artery dissection is a rare, sometimes fatal traumatic condition, with 80% of cases affecting women. The coronary artery develops a tear, causing blood to flow between the layers, which force them apart. The authors present the case of a multiparous parturient who suffered an acute myocardial infarction with right coronary artery dissection at 32 weeks’ gestation. The patient subsequently experienced preeclampsia and preterm labor. She delivered by cesarean delivery under general anesthesia at 35 weeks’ gestation.
Keywords: Coronary dissection, general anesthesia, myocardial infarction, pregnancy.
Version: 2012;80(1):32-36.Authors: Antonio D. Moore, CRNA, MS, CCRN,
Jennifer Hill, MD
Anesthetic Management of a Pediatric Patient Undergoing a Pancreatoduodenectomy With Portal Vein Reconstruction Pediatric pancreatoduodenectomy cases are rare in the current literature and unreported in the anesthesia literature. This case report describes the anesthetic management of a 17-year-old girl who underwent a pancreatoduodenectomy with portal vein reconstruction. Despite substantial intraoperative blood loss, the patient was resuscitated and extubated and was comfortable at the conclusion of the case. The anesthesia team prepared for the case by establishing adequate preoperative venous access and having sufficient blood available.
The Use of High-Fidelity Simulation in the Admissions Process: One Nurse Anesthesia Program’s ExperienceNurse anesthesia programs across the country are frequently in search of better selection criteria and more efficient evaluation systems. Incorporating high-fidelity simulation into the interview process may provide a useful tool to assist admissions committees in identifying “best” candidates for nurse anesthesia programs. The findings of this study revealed a positive correlation between face-to-face interview scores and simulation interview evaluation tool scores, which shows that candidates who performed well in face-to-face interviews also performed well in simulation scenarios.
Version: 2012;80(1):43-48.Authors: Barbara Penprase, RN, PhD, CNOR
Lisa Mileto, CRNA, MS
Andrea Bittinger, CRNA, MSN
Anne Marie Hranchook, CRNA, MSN,
Jana A. Atchley, CRNA, MSN,
Sarah A. Bergakker, CRNA, MSN,
Treavor J. Eimers, CRNA, MSN,
Holly E. Franson, CRNA, MSN
Selective Bilateral Bronchial Intubation for Large, Acquired Tracheoesophageal FistulaThe anesthetic management of patients undergoing tracheoesophageal fistula repair often involves lung separation, usually selective bronchial intubation with a double-lumen endotracheal tube. However, in patients with airway fistulas arising below the tracheal lumen, selective lung ventilation and separation may require unusual methods of airway management. The authors of this case report conclude that future cases involving complex airway fistulas should consider endotracheal tube limitations and other methods of providing ventilation such as high-frequency jet ventilation or cardiopulmonary bypass.
Catecholamine-Resistant Hypotension Following Induction for Spinal ExplorationIn this case study, the author describes a patient who received preoperative angiotensin II receptor blockers and experienced profound hypotension shortly after induction that proved resistant to conventional treatments with fluid boluses, phenylephrine, and ephedrine. Such refractory hypotension is uncommon in the general patient population. A solid understanding of the physiologic mechanisms of blood pressure control and the effects of various medications on these mechanisms is essential for anesthesia providers.
Keywords: Blood pressure regulation, catecholamine resistant hypotension, complications, drug interactions, general anesthesia.
Version: 2012;80(1):55-60.Authors: Jason Trotter, CRNA, MSN
AANA Journal Course: Update for Nurse Anesthetists—Part 6—Awake Craniotomy: A Practice OverviewAwake craniotomies are surgical techniques that enable surgeons to avoid damaging normal cerebral regions and allow real-time patient feedback. The role of anesthesia providers is critical in gaining the trust and motivation of the patient. Preoperative evaluation, regional anesthesia, general anesthesia, and monitored anesthesia are necessary to achieve a successful surgical intervention with awake craniotomy. In this course, discussion includes anesthetic objectives for awake craniotomies, preoperative preparation, induction, scalp block, intraoperative wake up, cortical mapping, and the future of awake craniotomy.